Big and Small Ideas by Rudy Owens

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A massacre in Colorado and public health’s chilling silence to gun violence

Like many people in the United States and around the world, I was horrified by the news on July 20, of yet another mass murder in the United States involving firearms. We still do not know as I write this post the motives of the alleged suspect, a 24-year-old medical student named James Holmes. Nor do we know yet how he acquired the multiple firearms—a semi-automatic rifle, a shotgun, and a pistol, according to initial reports—used to kill 12 people and leave 59 wounded. Press reports quote police officials saying he bought his firearms legally along with 6,000 rounds of ammunition. We do know that neither President Barack Obama or GOP presumptive contender Gov. Mitt Romney uttered the word “gun” in their public comments the day after the mass murders.

Alleged mass murderer James Holmes in a photo published by many media sources.

For his part, New York City Mayor Michael Bloomberg, a billionaire who does not have to worry about his political career even if he is voted out of office and who can afford to defy special interest groups because of his great personal wealth, was quick to criticize both presidential candidates for failing to put forward plans to address gun violence, which is a concern of many elected officials in any sized city. “Soothing words are nice,” said Bloomberg, “But maybe it’s time the two people who want to be president of the United States stand up and tell us what they’re going to do about it, because this is obviously a problem across the country.”

Boston Globe columnist Derrick Z. Jackson wrote on July 21: “Gun control has so completely disappeared from debate that John Rosenthal, founder of the Newton-based Stop Handgun Violence, told me this week before the Aurora shootings: ‘I’ve never seen more spineless cowardice and lack of national leadership. Can you imagine the outrage if instead, 83 Americans a day died from hamburgers?’ Instead the conservative Supreme Court struck down urban handgun bans. Last year saw record gun sales in America, based on FBI background checks, as the gun lobby whips up utterly false fears about Obama taking people’s guns away.”

Such mass killings like we saw in Aurora, Co., now occur with alarming frequency in the United State. Where I live, Seattle, we have experienced a wave of mass shootings during the last two months, the most lethal at a University District area restaurant called Café Racer and elsewhere in the city on May 30, that left six dead, including the alleged gunman.

From a purely statistical perspective, firearm violence is a national health issue, if not a crisis. The Centers for Disease Control and Prevention (CDC) reports that the number of firearm homicides in 2010 in the United States was a whopping 11,493, or 3.7 deaths per 100,000. And the role of firearms in suicides was nearly twice that rate. The CDC for 2010 attributes firearms in the suicides of 18,735 persons in the country, or a rate of 6.1 per 100,000. All told firearms are linked to 30,228 deaths annually at last count. This is a truly staggering figure, and one that should have the entire medical and public health community demanding that moral and political leaders in this country develop a broad array of interventions to reduce these numbers, the way we mobilize yearly to dress in pink and run against breast cancer or embrace other campaigns designed to save lives and promote health. By contrast, Japan counted 11 homicides related to firearms in 2008, or a rate of 0.0 per 100,000 in epidemiological terms.

So why is the medical and public health community silent? Well, the answer is simple. It is about politics and money. Specifically, it is about the lack of federal money. And of course those who should be out front on this issue, including heads of hospitals and medical associations as well as faculty and heads of health sciences universities, are not demonstrating the needed moral courage to speak truth to the supporters of the NRA, business interests, and political groups, who exploit American fears about government and who seek to maintain the status quo politically through fear-mongering. That job is mainly falling to journalists and citizens groups mostly, as well as victims of crimes and their families.

The Nieman Foundation at Harvard University reported in February 2012 that the gun industry’s main lobbying arm, the National Rifle Association (NRA), has “systematically suppressed data about gun violence and the impact it has on Americans’ lives.” The CDC in the early 1990s was releasing studies that found that guns in the home presented a greater danger to the occupants than potential home invaders. In response the NRA helped to prevent the funding of research on firearms’ death and injury. As a result, reports the foundation, the CDC appropriations bill the last 15 years has contained this language: “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” And this year, the NRA successfully added a similar amendment to the National Institutes of Health (NIH) appropriations language.

The most well-known advocacy group that promotes strict gun regulation, the Brady Campaign to Prevent Gun Violence, was extremely critical of the CDC in 2011 for, in its words, requiring researchers financed by the CDC to give the CDC a “head’s up” when they prepare to publish firearms-related research. The CDC, in turns, shares that information with the NRA as a courtesy. “If the CDC is allowing the NRA to review its studies, it’s a deeply troubling practice,” said Brady Center President Paul Helmke. “To have a government agency open itself and its science to the influence of any interest group, particularly one whose policies undermine the safety of our families and communities, is improper, offensive, and unjustifiable. We need science that we can trust.”

One has to look no further than the Department of Health and Human Services’ (DHSS) exhaustive annual report called Health, United States, 2011. It lists the word firearms just nine times, and buries firearms data deep into the report, making that information effectively unimportant in the overall health assessment for the country. Meanwhile the introduction to that report profiles motor vehicle deaths (about 40,000 deaths annually) and does not profile death by firearms (suicide or homicide, which number more than 30,000 annually). One has to wonder how connected the funding ban is to this type of editorial decision by the DHSS and the CDC, which publish this document.

Of course many proponents of very limited gun control disagree firearms-related violence is a “health” issue. One pro gun blog, published by a group called AmmoLand.com, calls those who would choose to address firearms safety “elite gun banners.” (The those being criticized is the CDC.)

Which item does the CDC and many public health research universities consider more of a public health threat, and which receives more research dollars and scholarly attention?

What we are seeing, at least at public health departments through funding mechanisms, is a full-court press on chronic disease linked to unhealthy food like, oh fatty french fries. When it comes to clogged arteries but not loaded semi-automatic weapons, the CDC doles out millions dollars ($103 million at last count) through Community Transformation Grants. It continually baffles me how trained scientists who work in health care flat out follow the money to pursue research grants to get more people to eat fruits and vegetables and stop smoking while keeping mostly silent as people in their communities are gunning themselves down and others.

I never understood this during my studies at the University of Washington School of Public Health, where there is not one course where firearms issues are addressed as a public health priority, at least according to my understanding of the courses offered. I did a quick search on the UW SPH web site on July 21 and found just seven references to firearms, six to guns, and 233 references to obesity. (UW researchers were involved in a joint study published in 2012 about gun storage cabinets in Alaska, but one would expect more given the numbers.) But this is no different than at any publicly funded health research university that relies on large federal grants to sustain its faculty and facilities. Clearly this impacts what future public health leaders are taught. During my two years in my program at the UW SPH, which used problem-based learning and cases that touched on everything from obesity to smoking to HIV/AIDs to homelessness to influenza, our classes never discussed firearms violence as a public health concern. (Note, that changed this year for the class behind me thanks to comments raised by my cohort to faculty for suggesting new topics).

In my frustration today, I even wrote to my member in the U.S. House of Representatives, Dr. Jim McDermott, by clicking the on the topical area of “gun control” to submit my email to his staff. I know from past experience that federal lawmakers never read 99% of such emails, and their replies usually do not address the contents of constituent communications, instead relying on general policy statements that amount to little substance. Still, I felt compelled to express my continued disappointment at the failure of leadership that he and others are demonstrating on this health and policy issue:

“As a public health professional and as your constituent, I am writing today to ask if you can inform your constituents what you and your allies, including in the health community and law enforcement community, are planning to do in terms of a meaningful policy response to address the proliferation of firearms and in terms of providing funding to health professionals to begin to address this issue as a legitimate threat to the health of U.S. citizens? Can you provide any details about how you are working locally with groups seeking to have upstream and federal actions to begin to chip away at the powerful special interest groups that have hijacked the public debate on firearms? Are you seeking to challenge blue dog Democrats or Republicans who continue to communicate talking points that equate the Second Amendment of the Constitution with the sale of personal weapons that in no way correspond to the wording or intent of the Constitution or the intent of the framers of the Constitution? I await your leadership. If there is to be no action, than one wonders why there continues to be cynicism of citizenry about the leaders we elect to Washington to do the people’s business, not the business of special interests that are allowing weapons manufacturers to profit from the misery of innocent citizens wiped out by a completely controllable problem, were there true courage and leadership to face down the attack ads. People can lead, but well, so can the leaders we elect. I await to hear your strong voice.”